Thursday, February 28, 2013

The head of smoking cessation treatment for the University of Pennsylvania Health System - Dr. Frank Leone - has spoken out against the recently announced ban on the hiring of nicotine users, arguing that it may not actually decrease health care costs.

In an article published by Newsworks, Dr. Leone called the policy "regressive" and suggested that job applicants who smoke are likely to hide their cigarette use, making it subsequently impossible for them to join smoking cessation programs without risking job termination.

According to the article: "The
head of the University of Pennsylvania's smoking treatment program said
the health system's new policy not to hire smokers is a bad one. The clinics and hospitals within the system will no longer hire
tobacco users starting July 1 of this year, according to a Penn Medicine
careers website. It's an effort to improve employee health and cut down
on healthcare costs. New hires will be required to self-report and will
face disciplinary action, up to termination, if they are caught in a
lie. Dr. Frank Leone, director of Penn's Comprehensive Smoking Treatment
Program, doesn't think it will improve health or cut down on healthcare
costs. "People have dealt with this for a very long time, desperately
wanting to quit, unable to quit, confused about why they can't quit,"
Leone said of smokers. Then, in order to get a job they really need, he said they will have to say they don't smoke. "It's hard to imagine a person doing anything but really just hiding
the fact that they're a smoker," Leone said. "And once that happens,
particularly in a healthcare institution, the chances that they'll go
and seek care for the problem go down considerably in my mind." Smokers in hiding will still be employed, but won't take advantage of
employer-offered smoking cessation programs, and healthcare costs will
not be impacted, Leone argued.

The Rest of the Story

Dr. Leone presents an intriguing argument. It is likely that many applicants who smoke will simply hide that private behavior from the employer. However, once hired, they will have to keep that behavior hidden because if exposed, it could cost them their jobs. Therefore, they are unlikely to take part in smoking cessation programs or other employer-offered incentive programs to help them quit smoking.

In the same article, Lewis Maltby, head of the National Workrights Institute, offers a compelling argument against UPenn's employment discrimination policy: "What
you do in your own home on your own time, is none of your boss's
business. Everything you do in your private life affects your healthcare
costs. What you eat. Do you consume alcohol? How do you get around? Do
you drive a car or ride a bicycle? And, heaven forbid, you should ride a
motorcycle. If it's ok to tell people they can't smoke
in their own home because it impacts company medical costs, there is
nothing in your private life that isn't subject to employer control."

There is yet another argument against this policy which I didn't mention in yesterday's commentary. The policy applies not just to smokers but to all nicotine users. This means, presumably, that if a smoker is trying to quit smoking by using nicotine replacement therapy or electronic cigarettes, he or she is not eligible for employment. And if an ex-smoker has actually quit smoking successfully using NRT or electronic cigarettes, he too is ineligible for employment if he is continuing to use those replacement products.

This is ludicrous because it punishes smokers who are trying to quit. The policy, then, isn't about health but about an abstinence-only ideology.

Wednesday, February 27, 2013

According to article at MedPage Today, the University of Pennsylvania Health System has announced that starting July 1, it will engage in employment discrimination against smokers.

According to the article: "The University of Pennsylvania Health System (UPHS) will stop hiring
people who use nicotine at its Pennsylvania locations beginning July 1. The
ban will not apply to the crop of residents who begin this summer, but
will be in force for applicants for 2014 residency slots. Last year,
there were 1,975 full-time faculty, 769 medical students, 775 PhD
students, 1,135 residents and fellows, and 789 post-doctoral candidates
working in the nearly 18,000-employee health system."

The primary reason given for the implementation of employment discrimination by the University of Pennsylvania Health System is that it will save health care costs.

The Rest of the Story

I believe that employment discrimination is wrong. Employees should be hired based on their bona fide qualifications for a job, not based on a group to which they happen to belong when that group membership does not relate to a specific job qualification. Once employment discrimination is justified on the grounds of saving money, then the same reasoning would justify discriminating against obese people, persons who consume alcohol, individuals who do not wear seat belts, persons who talk on their cell phones while driving, motorcyclists, and virtually any other group that an employer does not want to hire.

Interestingly, the UPenn Health System policy will not apply to its employees in New Jersey because that state has a law which bans employment discrimination against smokers. Given the way these policies are spreading, it would not surprise me if more states enact anti-discrimination policies to prevent this increasing form of employment discrimination.

Tuesday, February 26, 2013

According to Breathe California of Sacramento-Emigrant Trails (ALA), "Smoking Kills About 340 Young People a Day."

That means that every year, 124,000 young people die from smoking.

While smoking is obviously a terrible public health problem and it is
estimated to cause over 400,000 deaths per year, it is simply not true
that 124,000, or 31% of those deaths, occur among "young people." It is
rare for smoking to kill people below the age of 40. Most of the deaths
from smoking are caused by heart disease, lung cancer or other cancers,
and chronic lung disease -- all of these are conditions that generally
do not set in until at least middle-age. Only rarely does one see a
young adult die from smoking.

This is not to minimize the health
effects of smoking; it is merely to point out that the statistic being
communicated by this anti-smoking group is factually inaccurate.

The
casual observer might understandably surmise that this communication on
Breathe California of Sacramento-Emigrant Trails' web site is simply an
honest or careless mistake.

The Rest of the Story

The
rest of the story is that Breathe California of Sacramento-Emigrant
Trails has been aware of this inaccurate statistic on its web site since
at least October 22, 2007,
when I first notified the group of the error. If this were just an
innocent mistake, I think it would be reasonable to assume that the
organization would quickly change the web page to correct the mistake.

However, as you can see, the "mistake" persists to this day.

In
fact, several months after I first wrote to the group, asking why they
hadn't yet changed the web page, I was told that the reason for the
failure to correct this statistic was that the web master was
unavailable (presumably on vacation).

All I can say now is that
it's been one heck of a long vacation: from October 22, 2007 to February 26, 2013. That's five and a half years! I would love to have that web master's job.

I
really don't understand this need to lie to the public, or to stretch
the truth beyond recognition, in order to make a point to the public.

Based on the fact that the organization has presumably known about
this inaccurate statistic for the past five and a half years yet failed to correct
it, it seems implausible to me that Breathe California of
Sacramento-Emigrant Trails has any sincere interest in making sure that
it communicates truthfully and accurately to the public. If it did, then
why would it not have corrected the problem?

When I find a mistake on my web site,
I correct it immediately. I don't wait five and half years. And while it's true
that I don't have a web master who I need to contact to make the
correction, I find it hard to believe that any web master is completely
out of the reach of modern-day communication for five consecutive years.

Instead,
it seems to me that perhaps the organization just doesn't care about
the scientific accuracy of its public claims. After all, the end goal is
viewed as a noble one, so what does it matter if you stretch the truth a
little?

Monday, February 25, 2013

According to an article in the Winston-Salem Journal, the current head of the FDA's Center for Tobacco Products - Dr. Lawrence Deyton - is stepping down and will be replaced by Mitch Zeller, who heads a firm that does consulting work for Big Pharma.

According to the article: "What could make Zeller’s appointment controversial is he currently
serves as an executive with Pinney Associates, a pharmaceutical
consulting firm that does work for GlaxoSmithKline, the top seller of
nicotine-replacement therapy products." ...

"In October 2010, the consumer health care division of GlaxoSmithKline
requested that the FDA take Reynolds’ dissolvable tobacco products out
of test markets. GlaxoSmithKline sells nicotine-replacement therapy
products Nicorette and NicoDerm. In August, U.S. District Court Judge
Richard Leon denied the FDA’s attempt to have the manufacturers’ lawsuit
dismissed."

The Rest of the Story

In my view, this is an inappropriate appointment because it creates an unacceptable conflict of interest, thus mixing corporate politics with science and federal regulatory policy. This is precisely the type of appointment that President Obama promised to avoid when he stated in his first inauguration speech that it was time to take politics out of science.

Washington D.C. has become a virtual revolving door between corporate lobbyists/consultants and politicians/policy makers. This revolving door was what President Obama stated he would close in order to reduce corporate influence in the capital.

Now, however, we have an extreme example of conflict of interest and corporate influence. A pharmaceutical consultant is taking over a center of the very agency which regulates pharmaceuticals!

The conflict of interest is particularly inappropriate because one of the very first orders of business of the Center for Tobacco Products under Zeller's leadership will be promulgating regulations for the products that will compete with pharmaceuticals for the smoking cessation market: namely, electronic cigarettes and some other alternative nicotine-delivery devices. These regulations will have a major impact on the profits of GlaxoSmithKline, the top seller of nicotine replacement drugs and what appears to be the primary (if only) pharmaceutical company for which Zeller did consulting work.

This is tantamount to inviting GlaxoSmithKline to come to Rockville and issue its own regulations to govern its competitors.

The fact that Zeller is stepping down from his position at Pinney Associates to take this position is irrelevant, as it doesn't negate the conflict of interest.

Zeller has acknowledged that he "provides consulting support to GlaxoSmithKline Consumer
Health through Pinney Associates on an exclusive basis on issues related
to tobacco dependence treatment."

How can the FDA possibly appoint an individual with this severe a conflict of interest to head the center of the agency that will regulate GlaxoSmithKline's competitors?

To be clear, I am not questioning Zeller's other qualifications for the position. He is - otherwise - an outstanding choice for the position because of his extensive experience and leadership in the tobacco control movement and his prior service for the FDA itself. Unfortunately, however, the conflict of interest is unacceptable.

An article in the Wall Street Journal highlighted this conflict of interest:

"Mr. Zeller, an attorney and former official in the FDA's
Office of Tobacco Programs from 1993 to 2000, helped build the first nationwide
program to reduce youth access to tobacco. He was an executive at the American
Legacy Foundation, an anti-smoking organization, from 2000 to 2002 before
joining consultants Pinney Associates, where he advised pharmaceutical
companies such as GlaxoSmithKline on smoking cessation products." ...

"Michael Siegel, a professor at Boston University's School
of Public Health, thinks Mr. Zeller will likely take "a much more
hard-line approach" in his dealings with tobacco companies but voiced
concern that the incoming official has been paid to advise pharmaceutical
companies in recent years. Dr. Siegel said that represented a conflict of interest
as the FDA mulls how to regulate e-cigarettes, which are viewed by many
researchers to be far less harmful than combustible cigarettes and a potential
rival to FDA-approved quitting aids such as nicotine patches. An FDA spokeswoman said the agency
"assiduously" complies with ethics standards, including recusals if
there is any potential conflict of interest."

The FDA response is ridiculous. If the head of a major center at the agency needs to recuse himself from the chief decisions to be made by the center, then he simply shouldn't be heading the center.

Friday, February 22, 2013

Electronic cigarettes are here to stay. That is the conclusion of
both tobacco companies which have moved into the e-cigarette space and
financial analysts that specialize in following the tobacco space,
according to an article in the Winston-Salem Journal.

According to the article: "The mainstreaming of electronic cigarettes to consumers is
picking up speed, with Lorillard Inc. reported $61 million in sales for
fiscal 2012 and capturing 30 percent of the market share, even though it
has been in the category less than a year. ... Bonnie Herzog, a Wells Fargo Securities analyst,
thinks the e-cig craze has shifted from “fad” to “here to stay,” in part
because Lorillard and R.J. Reynolds Tobacco Co. are generating more
consumer confidence in the products than most of the little-known
marketers have to date. ... “This is a wonderful story of an industry that in
another 10 years could have gone the way of the dinosaurs, but will not
because science/innovation has been fashioned to fulfill consumers’
desire and demand,” said Stephen Pope, chief global market strategist
with Cantor Fitzgerald Europe, said in an email. ... E-cigs said could grow fast enough that Herzog said
they could affect the payments states receive from the landmark Master
Settlement Agreement, which draws from traditional cigarette sales.
Lower traditional cigarette sales are projected to lead to lower MSA
payments from the manufacturers."

The Rest of the Story

Stating
that the growth of electronic cigarettes could lead to a reduction in
MSA payments to states is another way of saying that electronic
cigarettes are such an effective substitute for tobacco cigarettes that
they will reduce in a substantial reduction in cigarette consumption.
And in turn, this means that the growth of electronic cigarettes will
result in a substantial reduction in cigarette-related morbidity and
mortality. In short, the more growth in the electronic cigarette space,
the more lives of smokers that will be saved.

This has the potential to be a tremendous public health success story. But two things stand in the way. Ironically, they are:

1. Anti-smoking groups; and
2. One of the nation's chief public health agencies - the FDA.

Many
anti-smoking groups and researchers continue to do everything they can
to discourage smokers from trying to quit smoking using electronic
cigarettes. In the very article which describes how useful electronic
cigarettes are in reducing cigarettes sales and saving lives, the
Campaign for Tobacco-Free Kids discourages smokers from using these
products to quit:

"Vince Williams, vice president of communications for Campaign for
Tobacco-Free Kids, said the growing use of e-cigs and increased
marketing “underscore the need for the FDA to quickly assert
jurisdiction over all tobacco products.” “The lack of regulation has allowed manufacturers to
get away with claims that these products have been proven to be safer or
can help smokers quit without having to provide any scientific evidence
to a government agency that these claims are true,” Williams said. “We
also don’t know what’s really in these products and what impact they
have on health.”"

Is the Campaign for Tobacco-Free Kids
actually arguing that there is insufficient evidence to conclude that
electronic cigarettes are safer than regular cigarettes? (That's
precisely what they are stating.)

Is the Campaign for
Tobacco-Free Kids actually challenging the contention that electronic
cigarettes cannot help smokers quit, despite the tons of evidence that
thousands of ex-smokers have quit using electronic cigarettes? (That,
too, is precisely what they are stating.)

Is the
Campaign for Tobacco-Free Kids actually asserting that we don't know
what's in electronic cigarette cartridges, despite the fact that we know
exactly what is in these cartridges? Sadly, that's exactly what
the Campaign for Tobacco-Free Kids is stating, and that statement is a
lie.

As I explained earlier this week, it is simply not
true that we really don't know what the ingredients in
electronic cigarettes are.
There have been well over 20 studies that have identified the chemicals
in electronic cigarette cartridges and/or vapor. Moreover, most
electronic cigarette companies list the ingredients of their products
right on their web sites.

There is certainly room for
debate about the precise role of electronic cigarettes in smoking
cessation and the nature of the regulatory framework that would be most
appropriate for these products. But there is no room for lying about the
facts to try to mislead the public and policy makers.

Tuesday, February 19, 2013

It appears that the current mantra among anti-smoking researchers who are asked to comment on electronic cigarettes is to respond something like this:

"Because the FDA has not approved these products, we have no idea what chemicals are contained in electronic cigarette vapor. Thus, we cannot recommend these products. Smokers should stick with FDA-approved smoking cessation products, such as the nicotine patch and nicotine gum, which have been proven to be safe and effective."

This mantra was re-iterated by Dr. Steinberg - the president of ATTUD (Association for the Treatment of Tobacco Use Disorders) - in a recent article in the Hudson Reporter. In the article, Dr. Steinberg was quoted as stating:

"Since none of the e-cigarette products are currently regulated by the
FDA, we really have no firm information about their safety. We don’t know for sure
what other chemicals are contained in the vapor, and how much nicotine
is delivered. The perception is that since they don’t contain smoke,
they are safe."

In the same article, the medical director of a smoking cessation program repeats the exact same mantra. He is quoted as stating:

"The e-cigarette is not regulated by the FDA. Therefore you don’t really know what the
ingredients are. You may indeed be playing with fire. In the United
States, tobacco is not considered a drug. Nicotine is an ingredient in
tobacco. Therefore they don’t have any jurisdication to regulate the
e-cigarette at this time. There’s no way to ascertain what nicotine
level you are trying to achieve."

It sounds like these two anti-smoking researchers/practitioners are quoting from an identical playbook.The Rest of the Story

The problem is that the playbook is a lie. It is simply not true that we really don't know what the ingredients in electronic cigarettes are. And it is also not true that we have no idea what chemicals are contained in electronic cigarette vapor.

In fact, we have a far more precise idea of what is in electronic cigarette vapor than we do of what is in cigarette smoke.

There have been well over 20 studies that have identified the chemicals in electronic cigarette cartridges and/or vapor. In 2011, Zachary Cahn and I reviewed the results of 15 such studies. At that time, we wrote:

"TSNAs have been detected in two studies at trace levels. The maximum level of total TSNAs reported was 8.2 ng/g. This compares with a similar level of 8.0 ng in a nicotine patch, and it is orders of magnitude lower than TSNA levels in regular cigarettes.Table 2 shows that electronic cigarettes contain only 0.07–0.2 per cent of the TSNAs present in cigarettes, a 500-fold to 1400-fold reduction in concentration. The presence of DEG in one of the 18 cartridges studied by the US Food and Drug Administration (FDA) is worrisome, yet none of the other 15 studies found any DEG. The use of a non-pharmaceutical grade of PG may explain this contamination."

"Other than TSNAs and DEG, few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns. Although the existing research does not warrant a conclusion that electronic cigarettes are safe in absolute terms and further clinical studies are needed to comprehensively assess the safety of electronic cigarettes, a preponderance of the available evidence shows them to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products."

You can find many of the studies that have been conducted here. While there is no question that further research needs to be done to understand the exact safety profile of these products, it is also clear that the anti-smoking playbook, which instructs researchers to argue that we simply don't know what is in electronic cigarettes, is essentially instructing them to lie to the public. We do know what is in the electronic cigarette.

And what we do know is that electronic cigarette users are not "playing with fire," as the medical director of the smoking cessation clinic suggests. On the contrary, electronic cigarette users are avoiding the fire - the fire that involves the combustion of tobacco, forming tens of thousands of chemicals and more than 60 known carcinogens.

Monday, February 18, 2013

As the Society for Research on Nicotine and Tobacco (SRNT) prepares for its annual meeting, which will be held next month here in Boston, it is becoming apparent that this supposedly objective scientific conference will be a scientific farce, devoid of objectivity.

Why? Because the Society, according to its web site, is still sponsored by three Big Pharma companies that manufacture drugs used for smoking cessation: Pfizer, Johnson & Johnson, and GlaxoSmithKline.

According to its web site, one of SRNT's basic values is: "Commitment to the promotion of excellence in science."

But how can the Society promote excellence in science when it is funded by pharmaceutical companies that manufacture smoking cessation drugs, thus creating a conflict of interest that establishes an inherent bias in the Society's considering of the scientific and policy issues related to smoking cessation.

Another of SRNT's stated values is: "Transparency, integrity, and honesty."

But how can SRNT claim a commitment to transparency, integrity, and honesty when its web page announcing the 2013 annual meeting fails to disclose any Big Pharma conflicts of interest and fails to notify attendees that the conference is supported by pharmaceutical companies? The preliminary program also fails to mention this funding.

The program also fails to disclose that a large number of the scientists presenting at the conference have personal financial conflicts of interest with Big Pharma.

Its pharmaceutical sponsorships create an
unavoidable bias that precludes a truly objective consideration of any
scientific issue that may have significant implications for the
profitability of smoking cessation drugs, and therefore, for their
manufacturers, who are SRNT sponsors. There is no way that the conference can objectively consider the role of
pharmaceutical smoking cessation products as part of a broad, national
strategy for smoking cessation when the Society, and thus the conference, is being funded by
the very manufacturers of many of those products.

Thursday, February 14, 2013

According to a press release issued on Tuesday, the UCSF School of Pharmacy is partnering with Safeway to offer smoking cessation advice to Safeway customers.

The press release states: "The UCSF School of Pharmacy has partnered with Safeway Inc. to help
Safeway customers quit smoking, by connecting them with specially
trained pharmacists to learn about smoking-cessation programs and other
resources. Under the partnership, Safeway's pharmacists will be trained in
proven smoking-cessation counseling techniques using a program developed
by the UCSF pharmacy faculty. The stores also will locate
non-prescription, nicotine-replacement therapies near store pharmacy
areas, giving customers convenient access to a pharmacist to answer
questions."

The press release quotes Safeway's senior vice president as boasting: "We are proud to partner with the UCSF School of Pharmacy on this effort
to help our customers quit smoking and live healthier lives. Our pharmacists are, at all times, ready to help customers
reach their health and wellness goals."

The Rest of the Story

What a load of hypocrisy?

If Safeway were truly interested in reducing tobacco-related morbidity and mortality and improving the health of its customers, it would take one simple action:

Stop selling cigarettes!

It's really not all that complicated. How can the Safeway company boast about how concerned it is about people's health out of one side of its mouth, and then out of the other side of its mouth fight to retain its right to sell cigarettes and kill those very same customers? Remember that Safeway sued the city of San Francisco because it didn't want the city to interfere with its profits from the sale of cigarettes, much of which comes from the sale of cigarettes to kids. Don't forget that studies showed that Safeway had the highest rate of cigarettes sales to minors of any supermarket chain and was sued by the state of California because of those illegal sales.

So this is the corporation that the UCSF School of Pharmacy chooses to partner with and lend its good name as a means of the corporation gaining positive publicity about its concern for its customers health?

Hooey. It's a load of crap. Safeway doesn't care about its customers' health. It cares about its cigarette-related profits. If Safeway were truly concerned about its customers' health, it would simply stop selling these deadly products.

If the UCSF School of Pharmacy really wanted to do something to reduce cigarette use, then instead of partnering with a huge culprit in the problem, it would use its influence to demand that the company stop selling these cancer sticks.

The rest of the story is that the UCSF School of Pharmacy is acting as an accomplice in the perpetuation of cigarette-related disease. The School is providing Safeway with an opportunity to deceive the public into making them think the corporation cares about health, when obviously its actions show that its primary concern is profit from cigarettes. It went so far as suing the city of San Francisco to preserve its ability to sell its cancer sticks to its customers. That's how much it cares about health.

Let's face it. Safeway is out to make a profit. It is not in the business of health. It's in the business of making money. And it has demonstrated that its perfectly happy to make its money off the sale of potenti and deadly carcinogens.

Wednesday, February 13, 2013

An article published online ahead of print in the journal Tobacco Control reveals the historical connections between the tobacco industry and the Tea Party. The article stresses the importance of communicating to policy makers, the media, and the public the connection between the tobacco industry and the Tea Party.

The Rest of the Story

It is important to point out that it is not just the Tea Party, and the Republican party, that have strong connections with Big Tobacco.

The rest of the story is that the Democratic party also has strong ties to Big Tobacco and its politicians are therefore heavily influenced by, and beholden to tobacco interests.

The following is a list of Democratic members of Congress who have accepted more than $10,000 in total contributions from the tobacco industry during the period 2005-2012.

Thus, a total of 22 different Democratic members of Congress accepted $10,000 or more of tobacco industry money during the past eight years. This amounts to $1.1 million in tobacco industry funding of Democratic Congressional members/candidates.

It is just not as simple as communicating to policy makers, the media, and the public that the Tea Party is heavily influenced by Big Tobacco, or that the Republicans take a huge amount of money from tobacco companies. The Democratic party has been bought off every bit as much as the other political parties. To deflect attention away from the connection between Democrats and Big Tobacco does not do justice to what is really going on.

Tuesday, February 12, 2013

Is the American Heart Association so desperate for money that it needs to partner with a company that sells billions of cigarettes each year?

Apparently so.

The American Heart Association is partnering with Walgreen's in a fund-raiser for the Association during the month of February. As first reported by Anne Landman at her blog, the American Heart Association is helping Walgreen's profit from cigarette sales: "AHA’s fundraising partnership with Walgreens brings AHA lots of money.
That’s clearly the reason, sad as it is, that AHA continues to maintain
it. AHA’s partnership in Walgreens’ annual “heart health” promotion
helps Walgreens keep fooling the public into believing the drug chain
really cares about peoples’ health. It doesn’t. All it cares
about is profits. What we are witnessing in this promotion is AHA
selling its credibility to Walgreens for cold, hard cash. The PR tactic
behind this unseemly alliance is called “healthwashing.” The American
Heart Association is helping Walgreens healthwash the chain’s continued
profiteering from the sale of deadly cigarettes."

As Landman also points out: "Walgreens says it promotes heart health, while continuing to also
sell the single biggest cause of heart disease: cigarettes. Walgreens
even goes to lengths to downplay smoking as a major cause of heart
disease on its website. Check this out: Walgreens’ “Heart Health FAQ” page,
another happy-talk web page, has a photo of apple with a cute little
heart in it and the tagline, “Make your whole heart happy with small
steps that can make a difference.” You would think THIS page would
contain information about the part quitting smoking plays in preventing
heart disease. Nope. ... As one of the country’s biggest cigarette outlets, Walgreens is an ally
of the tobacco industry and thus cares absolutely nothing about
customers’ health."

The Rest of the Story

Keep in mind that this is a company that acknowledges $9 million in annual cigarette sales in San Francisco alone. That's from 52 stores, just 0.6% of its U.S. total. Multiply that by 160 and you get more than $1 billion in annual cigarette sales.

And this is a company that the American Heart Association wants to partner with?

Monday, February 11, 2013

In an op-ed published in the Arizona Republic, the Southwest chapter of the American Lung Association has called for a federal ban on the television advertising of electronic cigarettes, protesting against an ad that appeared in the Phoenix area during the Super Bowl and urging the FDA to ban such ads in the future.

The American Lung Association writes: "We were stunned to see that twice during the nation’s largest
televised sporting events, the CBS affiliate in Phoenix aired a
commercial that touted the use of e-cigarettes. ... Costs were not spared in the creation of this polished and
professionally produced television commercial to deliver a misleading
message to the public. Ironically, the commercial promoted this
e-cigarette as the first with “a look, feel and flavor of the real
thing.” We would say that it has a whole lot in common with real
cigarettes."

"The U.S. Food and Drug Administration has found e-cigarette
cartridges labeled as nicotine-free often have traceable levels of
nicotine. That means a smoker using e-cigarettes hoping to slowly break his
nicotine habit is really exacerbating his addiction to the drug. To make matters worse, FDA tests have found detectable levels of
carcinogens and toxic chemicals, including an ingredient used in
antifreeze, in some e-cigarettes. ... E-cigarette companies sometimes say this product can help people stop smoking. Going well beyond views and studies of the American Lung Association
in Arizona, the World Health Organization knows of no evidentiary basis
for the marketers’ claims that the electronic cigarette helps people
quit smoking. The American Lung Association in Arizona believes nicotine use,
whether it is a regular cigarette or an e-cigarette, is still an
addiction."

The American Lung Association was also quoted in a separate Arizona Republicarticle as protesting against the electronic cigarette ad because it is promoting cigarettes and falsely claiming that these products can help people quit smoking: "“Whenever I see any kind of (cigarette) advertising that seems out of
place, I am certainly sensitive to it,” said Bill Pfeifer, president and
CEO of the American Lung Association chapter of the Southwest. “We are
trying to encourage people to quit smoking, and there is no scientific
evidence that these products help people kick their habit.”"

The Rest of the Story

Just about everything that the American Lung Association said about electronic cigarettes could also be said about nicotine replacement therapy (NRT), but the ALA - curiously - is not calling for a ban on NRT advertising on television.

Like electronic cigarettes, NRT represents a nicotine delivery system. If the ALA truly believes that "nicotine use,
whether it is a regular cigarette or an e-cigarette, is still an
addiction," then certainly NRT is also addictive and should not be promoted on television.

The ALA also complains that electronic cigarettes contain "detectable levels of
carcinogens." Well so do NRT products. So certainly, NRT advertising should also be banned on television. Why would we want to allow the advertising on television of a product that has detectable levels of carcinogens? How can the ALA possibly justify that stance?

The third prong of the ALA's argument is that electronic cigarette advertising should not be allowed on television because there is no evidence that it is helpful in smoking cessation. As I'll show below, that statement is a lie. The truth, in fact, is that the current evidence suggests that electronic cigarettes are actually more effective than NRT in smoking cessation.

The truth is that the NRT products which the ALA is promoting are a dismal failure. They work only about 8% of the time. They fail in the overwhelming majority of cases. So why should NRT ads - which are far more deceptive than electronic cigarette ads - be allowed on television?

The real deception here is not in the electronic cigarette company's ad, but in the American Lung Association's statement.

It is the American Lung Association that is lying when it states that there is no scientific evidence that e-cigarettes are an an effective cessation tool. Actually, there is abundant evidence that literally thousands (if not tens of
thousands) of electronic cigarette users have successfully used these
products to either quit smoking or to cut down substantially on the
amount that they smoke. A clinical trial has demonstrated that among
smokers who were not motivated to quit, 54% were able to quit completely or to cut down by at least half on the amount they smoke. And substantial evidence from the real-life use of these products by thousands of vapers documents that they can be effective in smoking cessation. In fact, the evidence for the effectiveness of electronic cigarettes in real-life settings (outside of clinical trials) is far stronger than that for NRT.

In light of the existing evidence, how can the ALA deceive the public by asserting that there is no evidence
for the potential of electronic cigarettes in smoking cessation? To do
so is to completely ignore the results of the clinical trial evidence,
as well as to ignore the multitude of anecdotal evidence based on
personal reports of ex-smokers. Perhaps the ALA has simply not reviewed the scientific evidence, but if that's the case, it is irresponsible to be putting out a statement like this in ignorance of the science on the issue.

If the ALA had asserted that the effectiveness of electronic
cigarettes in smoking cessation has not been definitively proven, that would be fine.
But to claim that there is no evidence that electronic cigarettes may be helpful in smoking cessation is simply a lie.

The worst part of this story is that at the end of the day, the American Lung Association is protesting against ads which are promoting smoking cessation. The reason why most electronic cigarette users try these products is because they want to protect their health by quitting smoking, and e-cigarettes are a viable alternative for smokers who have failed to quit using NRT or other drugs.

The rest of the story is that the American Lung Association has become blinded by ideology and has unfortunately lost its vision of protecting the public's health. Smokers must quit in the way the ALA prescribes, or else their quitting is invalid. Better that smokers should keep smoking and die then successfully quit using a product that the ALA does not endorse because it looks like smoking. Shame on the ALA, both for lying to the public and for standing in the way of smoking cessation for tens of thousands of smokers across the country.

Thursday, February 07, 2013

Since January 1, a number of major hospitals and health systems have implemented a policy of refusing to hire anyone who uses nicotine - in any form. This includes cigarettes, smokeless tobacco, or even electronic cigarettes or nicotine replacement therapy (NRT).

For example:

Beebe Medical Center (Lewes, DE) will not hire anyone who uses nicotine. The policy went into effect on January 1, 2013.

According to an article at KTXS.com, the purpose of the nicotine-free hiring policy at Hendrick Health System is to set a good example for the community: "Officials say this is a move toward being a role model for the community. "The
ultimate goal is really to promote wellness and set a good example for
the patients and the community we serve," said Maribeth Bunn, RN and wellness director."

The Rest of the Story

In what way does refusing to hire people who are trying to quit smoking using NRT or electronic cigarettes set a good example for the community?

If anything, one would think that a hospital or health care system would want to encourage, rather than punish people for trying to quit smoking.

How does a hospital serve as a role model for the community by ripping up the applications of smokers who are following doctors' advice and using nicotine replacement in an effort to quit? How exactly does punishing these quit efforts promote wellness?

It just strikes me that there is something else going on here. The stated justifications for these policies are so poor that it makes me think that there is an ulterior motive. And I believe that motive is an underlying desire to punish smokers, to make a moral judgment, and to cast dispersion on a way of life with which these businesspeople don't agree.

This is not about protecting the public's health. It is all about moralizing, castigating, and punishing.

Wednesday, February 06, 2013

A new study published in the International Journal of Environmental Research and Public Health reports the results of a pilot test of electronic cigarettes among 14 patients with schizophrenia who were heavy smokers.

The results were as follows: "Sustained 50% reduction in the number of cig/day at week-52 was shown in 7/14 (50%) participants; their median of 30 cig/day decreasing significantly to 15 cig/day (p = 0.018). Sustained smoking abstinence at week-52 was observed in 2/14 (14.3%) participants. Combined sustained 50% reduction and smoking abstinence was shown in 9/14 (64.3%) participants."

The Rest of the Story

While this study is small, the results are quite striking. Among a very difficult population of smokers with schizophrenia, a trial of electronic cigarettes was able to achieve a dramatic result: a sustained 50% reduction in cigarette consumption at 52 weeks for half of the treated patients, and complete smoking cessation among an additional 14%.

These results suggest that electronic cigarettes may be a particularly promising innovation for the most difficult treatment situations, giving practitioners the first viable option for smoking cessation in these populations. Of course further research is necessary to confirm these findings in larger studies. But the initial findings are quite promising.

Hopefully, research like this will convince the FDA that it would be devastating to the public's health to issue deeming regulations for electronic cigarettes that place these products under the same regulatory framework as tobacco cigarettes. Clearly, a separately carved out framework is necessary.

The study examined survey responses of 5,939 current and former smokers in the U.S., U.K., Australia, and Canada. It ascertained respondents' use of electronic cigarettes, smoking behavior, and reasons for trying electronic cigarettes. In addition, a longitudinal aspect of the study examined smoking patterns among electronic cigarette users and non-users in wave 7 of the survey (conducted October 2008 to July 2009) compared to wave 8 (conducted July 2010 to June 2011).

Among the electronic cigarette users interviewed at waves 7 and 8, the average level of cigarette consumption dropped from 20 cigarettes per day to 16 cigarettes per day, a reduction of about 20%. Among the non-users, consumption dropped from an average of about 17 cigarettes per day to 15 cigarettes per day, a reduction of about 12%. Thus, electronic cigarettes elicited about twice the overall level of reduction in cigarette consumption observed among non-users.

The study reports that 11% of electronic cigarette users quit from wave 7 to wave 8, but it is not possible to compare this to the proportion of nonusers who quit because that figure is not given in the paper.

Perhaps the most important finding of the paper is that the overwhelming majority of electronic cigarette users (85%) reported using these products in an attempt to quit smoking. Also, 75% of users stated that they were using the product to help them cut down on the number of cigarettes smoked, and 80% reported that they used electronic cigarettes to reduce the harmful effects of smoking.

The study concludes: "Because trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid once enforceable product standards are developed and effıcacy is established through clinical trials."

The Rest of the Story

This study adds to the growing body of scientific evidence that electronic cigarettes show promise as a potentially effective strategy for smokers to either quit smoking or to cut down substantially on the amount that they smoke.

This study confirmed that the overwhelming majority of electronic cigarette users are using these products to try to quit smoking or at least to reduce the amount that they smoke, and to reduce their health risks associated with cigarette smoking.

The fears of anti-smoking groups that these products are being marketed and used mainly as a way to get around smoking bans and that there is no true intent to get off of cigarettes are not borne out by this research.

The study authors seem to be pleasantly surprised by their finding that so many non-daily smokers are using electronic cigarettes, suggesting that these products are helping many people to severely cut down on the amount that they smoke. They argue that: "the use of ENDS may have driven smokers to reduce their overall cigarette smoking to a nondaily pattern."

The authors also argue that if electronic cigarettes can be shown in subsequent studies to aid smoking cessation without increasing smoking initiation, then "the net public health effect is likely to bepositive."

This article also makes one very important additional point. It states that: "Should regulatoryauthorities approve direct claims about reduced harm, one might expect greater adoption of these products, at least among current cigarette smokers."

This is important because it means that any FDA limits on the ability of electronic cigarette companies to point out the truth (that these products are safer than cigarettes) is going to discourage quit attempts using these products and therefore serve to help maintain and promote cigarette use. As I have argued previously, the FDA must not apply the modified risk provisions of the Tobacco Act to electronic cigarettes, or it will have devastating public health consequences.

Monday, February 04, 2013

Dr. Keith Ablow, a noted psychiatrist who is a medical news reporter for Fox News, published a column last week in which he recommended electronic cigarettes as a smoking cessation tool for smokers who fail to quit using other methods.

Dr. Ablow writes: "Since many of my patients have reported using electronic cigarettes
to successfully stop smoking, I now recommend the devices to anyone who
has tried to quit smoking cold turkey and failed. And I think it is time that other doctors do, too."

Dr. Ablow also comments on the reason that electronic cigarettes appear to be effective for many smokers: "The reason my patients tell me electronic cigarettes work better than
the patch or nicotine gum is that they simulate the act of smoking, but
not perfectly. They are good enough to substitute for real cigarettes,
but they aren’t good enough to become an addiction, in and of
themselves. An analogy in the arena of food addiction would be
something low calorie that fills you up enough to prevent bingeing on
sweets, gives you some distance from that addiction, but then becomes
forgettable, because it isn’t really all that compelling.
It is, of course, imperative that the electronic cigarette be a
good-enough fake."

While acknowledging that there are some potential health concerns, Dr. Ablow emphasizes that these products are undeniably much safer than tobacco cigarettes: "There is certainly controversy about whether electronic cigarettes
are harmless. Critics note that they do, of course, contain nicotine
(which is the whole idea, after all). And critics have also found other
substances in the vapor released by electronic cigarettes—even
cancer-causing substances, but in tiny, tiny amounts that proponents of
the devices claim would have no negative effect on well-being at all. What no one seems to argue about is that electronic cigarettes—from
LOGIC or Blu or any leading brand—are not nearly as dangerous as smoking
real cigarettes. LOGIC claims its device avoids 4,000 toxins that are
found in cigarettes."

Dr. Ablow concludes: "Given my experiences and those of numerous clinicians I have spoken
with, it would seem to be a good time to conduct large scale clinical
trials in which patients who smoke are given electronic cigarettes by
their doctors, encouraged to use them and then quizzed on their use of
real tobacco weeks and months and years later. If the data generated
support the product, then it may be wise for medical insurance companies
to offer electronic cigarettes to smokers for free. My bet is they
would save lots of money—from the costs of treating heart disease and
cancer—down the road."

The Rest of the Story

It is refreshing to read an insightful, balanced, and evidence-based perspective on the potential role of electronic cigarettes in tobacco control, rather than the kind of biased, ideologically narrow, and scientifically misguided missives against electronic cigarettes that we are seeing so much out of anti-smoking advocates these days.

It seems beyond argumentation that electronic cigarettes should be recommended as an option for smokers who want to quit but have failed using other "established" methods. Why wouldn't anti-smoking advocates want to encourage such smokers to try to quit smoking with a device that has been so successful for literally tens of thousands of smokers across the country?

As Dr. Ablow points out, electronic cigarettes occupy a niche that is perfectly situated: they simulate smoking closely enough to be effective substitutes for smokers trying to quit, but not so closely enough to be an attractive option for youths.

Large scale clinical trials of electronic cigarettes should become a research priority for NIH and other government agencies.

About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.